Individual provider Active NPI

Thomas W Wing, O.D.

  • Optometrist
  • Sacramento, CA
National Provider Identifier
1700988011
Registry record updated Jan 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5794T Issued in CA
Practice address
6320 Mack Rd
Sacramento, CA 95823-4646
Phone
(916) 421-3986
Fax
(916) 421-5470
NPI assigned
Sep 5, 2006
Last updated
Jan 28, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5794T CA Primary

Addresses

Primary practice location

6320 Mack Rd
Sacramento, CA 95823-4646

Mailing address

6320 Mack Rd
Sacramento, CA 95823-4646
Phone (916) 421-3986

Other identifiers 1

IdentifierTypeStateIssuer
SD0057940MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120327000934 CA Practitioner - Optometry 0446360176 Practice locations: Sacramento, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201478400000",
    "number": "1700988011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6320 MACK RD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958234646",
            "telephone_number": "916-421-3986",
            "fax_number": "916-421-5470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6320 MACK RD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958234646",
            "telephone_number": "916-421-3986",
            "fax_number": "916-421-5470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WING",
        "first_name": "THOMAS",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2008-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "5794T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0057940",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.